Nose Injuries

Topic Overview

Nose injuries often occur
during play, sports, accidents, fights, and falls. Pain, swelling, and bruising
are common, even with minor injuries. Home treatment can usually help relieve
your symptoms.

It may be hard to tell if your
nose is broken. Swelling can make your nose look crooked even if it is not
broken. When the swelling goes down after a few days, it is easier to tell if
your nose is really crooked. Most doctors prefer to check an injured nose
soon after the swelling has gone down. Sometimes, testing may be needed, such
as an
X-ray or
computed tomography (CT) scan of the head, if other
facial injuries or fractures are suspected. See a picture of a
broken nose.

Seriousness of a nose injury

Whether or not your nose
is broken, a nose injury is more serious when:

The skin of your nose is cut or
punctured, especially if you think your nose may be broken. This increases your
risk of
infection.

A blood clot forms in the
tissue that separates the nostrils (septum). This
can create a hole (perforation) in the septum or cause the bridge of the nose
to collapse (saddle nose deformity).

You think the injury may have
been caused by
abuse. Physical abuse often causes bruises, burns,
fractures, head injuries, and other injuries. If you suspect abuse, seek help.
You can call a local child or adult protective services agency, the police, a
spiritual adviser, or a health professional such as a doctor, nurse, or
counselor.

You have
persistent drainage from one or both nostrils. This may be caused by
cerebrospinal fluid (CSF) draining from the brain into
the nose (CSF rhinorrhea) and can occur after a head injury or after surgery on
the nose or ears. There is a chance you may get a CSF infection, such as
meningitis, which can affect the nervous system and be
life-threatening.

Complications of a broken nose

Most broken noses heal
without problems. When problems develop, they can include:

A change in the size or shape of the nose, or a
crooked or bent nose. Multiple nose injuries, especially during childhood,
increase the risk of damage to the tissues and structures in the nose. This can
cause long-term problems.

Severe infection,
such as meningitis or a
brain abscess, or other CSF infection.

Treatment

Treatment of a simple fracture, when the
bone is still in place, usually includes pain medicine and nasal decongestants.
You may or may not need a nasal splint.

If your nose is broken and
out of place, it may need to be set. Most doctors like to wait for any swelling
to go down before setting a broken nose. Most swelling goes down after 2 or 3
days but may take as long as 7 to 14 days. After the nose is set, nasal packing
may be inserted and a splint may be applied. You may be given antibiotics to
help prevent infection if packing is used. Your doctor may want to recheck your
nose and remove the packing in 2 to 3 days.

When you have a nose injury, it is important to look for
other injuries to the head, face, and neck, such as a broken cheekbone, an eye
injury, an injury to the mouth or teeth, or a cervical spine injury. If you
think there are other injuries, use the topics in the Related Information
section to evaluate these injuries.

After passing out, it's normal to feel a little confused, weak, or lightheaded when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do.

Sit up straight, and tip your head slightly
forward. (Do not tilt your head back. This may cause blood to run down your
throat and make you vomit.)

Pinch the soft part of your nose shut with your thumb and
index finger for 10 full minutes.

After 10 minutes, check to see
if your nose is still bleeding. If it is, pinch it shut for 10 more minutes.
Most nosebleeds will stop after 10 to 20 minutes of pressure.

Pain in adults and older children

Severe pain (8 to 10): The pain
is so bad that you can't stand it for more than a few hours, can't sleep, and
can't do anything else except focus on the pain.

Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it's severe when it's
there.

Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.

Many things can affect how your body responds to a symptom and what kind
of care you may need. These include:

Your age. Babies and older
adults tend to get sicker quicker.

Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
disease, you may need to pay closer attention to certain symptoms and seek care
sooner.

Medicines you take. Certain
medicines, herbal remedies, and supplements can cause symptoms or make them
worse.

Recent health events, such as surgery
or injury. These kinds of events can cause symptoms afterwards or make them
more serious.

Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
use, sexual history, and travel.

Head Injury, Age 3 and Younger

Objects in the Nose

Head Injury, Age 4 and Older

Eye Injuries

Make an Appointment

Based on your answers, the problem may not improve without medical
care.

Make an appointment to see your doctor in the
next 1 to 2 weeks.

If appropriate, try home treatment while you
are waiting for the appointment.

If symptoms get worse or you have
any concerns, call your doctor. You may need care sooner.

Shock is a life-threatening condition that may occur quickly
after a sudden illness or injury.

Symptoms of shock in a child may include:

Passing out.

Being very sleepy or hard
to wake up.

Not responding when being touched or talked to.

Breathing much faster than usual.

Acting confused.
The child may not know where he or she is.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and
arrange for care.

If you cannot reach your doctor or you don't have
one, seek care in the next hour.

You do not need to call an
ambulance unless:

You cannot travel safely either by driving
yourself or by having someone else drive you.

You are in an area
where heavy traffic or other problems may slow you down.

Shock is a life-threatening condition that may quickly occur
after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

Passing out.

Feeling very dizzy or
lightheaded, like you may pass out.

Feeling very weak or having
trouble standing.

Not feeling alert or able to think clearly. You
may be confused, restless, fearful, or unable to respond to questions.

You may need a tetanus shot depending
on how dirty the wound is and how long it has been since your last shot.

For a dirty wound that has
things like dirt, saliva, or feces in it, you may need a shot if:

You haven't had a tetanus shot in the past 5
years.

You don't know when your last shot was.

For a clean wound, you may
need a shot if:

You have not had a tetanus shot in the past 10
years.

You don't know when your last shot was.

Severe trouble breathing means:

You cannot talk at all.

You have to
work very hard to breathe.

You feel like you can't get enough
air.

You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

It's hard to talk in full
sentences.

It's hard to breathe with activity.

Mild trouble breathing means:

You feel a little out of breath but can still talk.

It's becoming hard to breathe with activity.

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).

It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Symptoms of a skull fracture may
include:

Clear or bloody fluid draining from the ears or
nose.

Bruising under the eyes or behind the
ears.

Drooping of the face.

A dent anywhere on the head.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The
pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
constantly no matter what you do. The baby may kick, make fists, or
grimace.

Moderate pain (5 to 7): The baby is
very fussy, clings to you a lot, and may have trouble sleeping but responds
when you try to comfort him or her.

Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
when you try to comfort him or her.

Severe trouble breathing means:

The child cannot eat or talk because he or she is
breathing so hard.

The child's nostrils are flaring and the belly
is moving in and out with every breath.

The child seems to be
tiring out.

The child seems very sleepy or confused.

Moderate trouble breathing means:

The child is breathing a lot faster than
usual.

The child has to take breaks from eating or talking to
breathe.

The nostrils flare or the belly moves in and out at times
when the child breathes.

Mild trouble breathing means:

The child is breathing a little faster than usual.

The child seems a little out of breath but can still eat or talk.

Home Treatment

First aid measures are important
after a nose injury.

Stop a nosebleed. Crying can make a
nosebleed worse. If your child has a nosebleed and is crying, speak to the
child in a quiet, relaxed manner. This will help reduce the child's fear. For
more information, see the topic
Nosebleeds.

If you think that the nose is
broken, do not try to put a crooked nose back in place.
This may increase bleeding or deformity or cause further injury.

Measures to reduce pain, swelling, and bruising

Use ice. Cold will
reduce pain and swelling. Apply an
ice or cold pack immediately to prevent or minimize swelling. Apply the ice
or cold pack for 10 to 20 minutes, 3 or more times a day. Always keep a cloth
between your skin and the ice pack, and press firmly against all the curves of
the affected area. Do not apply ice for longer than 20 minutes at a time, and
do not fall asleep with the ice on your skin.

Keep your head
elevated, even while you sleep. This will help reduce swelling.

Do
not take nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen (Advil or Motrin) or aspirin for the first 48 hours. Aspirin prolongs the clotting time of
blood and may cause more nose or facial bleeding. Also, do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome, a rare but serious disease.

Do not smoke. Smoking slows healing because it decreases blood supply and
delays tissue repair. For more information, see the topic
Quitting Smoking.

Measures to relieve nasal stuffiness and promote sinus drainage

Drink plenty of fluids. Extra fluids help keep
mucus thin and draining, which may help prevent blockage of the sinuses.

Aspirin (also a nonsteroidal
anti-inflammatory drug), such as Bayer or Bufferin

Talk to your child's doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine.

Safety tips

Be sure to follow
these safety tips when you use a nonprescription medicine:

Carefully read and follow all
directions on the medicine bottle and box.

Prevention

While not all nose injuries can be
prevented, you can take steps to help reduce your risk of a nose injury.

Wear a helmet and face guard to protect your
head, face, and mouth during sports activities in which facial injuries may
occur.

Always use car safety seats and seat belts to prevent or
reduce nose and facial injuries during a car accident.

Wear a face
shield when you work with power tools or when you do an activity that might
cause an object to fly into your face.

Reduce your child's risk of injury

You can take steps
to help reduce your young child's risk of a nose injury.

Never leave your child unattended in a high
place, such as on a tabletop; in a crib with the sides down; on elevated
porches, decks, and landings; or even on a bed or sofa.

Do not
leave your child alone in any infant seat or sitting toy, such as a swing or
jumper. Use all of the safety straps provided.

Use stair gates to
block stairways. Install gates at the top and bottom of the stairs, and use the
gates properly.

Do not use baby walkers. Baby walkers have caused
many injuries and are not safe even if the baby is watched
closely.

Watch your child when he or she is outside. Uneven grass,
sloping lawns, and hills may be difficult for your child to walk
on.

Make your home safe from falls by removing hazards that might
cause a fall, such as throw rugs.

Place your child in an approved
child car seat when traveling in a car. Follow the
manufacturer's directions for securing the seat in the car. Children should
ride in the back seat for safety.

Have your children wear helmets when necessary, such as when they are passengers on a bike or are riding a
tricycle or bicycle on their own. Be sure your child wears a helmet or protective clothing when he or she does sports activities to prevent sports injuries.

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